tbuckley/cabot-search huggingface dataset:
Abstract 12545: Adoption of Sacubitril/Valsartan in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction: The AHA Get With The Guidelines - Heart Failure Registry
Authors: Jacob B Pierce, Zhen Li, Melissa Greiner, STEVEN LIPPMANN, Natalie C Hardy, Xian Shen, Mark Stampehl, Robert J Mentz, Larry A Allen, Pamela Peterson, Gregg C Fonarow, Emily C Obrien, Stephen J Greene
Journal: Circulation (2022)

Introduction: In February 2021, the US FDA expanded the indication for sacubitril/valsartan (S/V) to include patients with heart failure (HF) with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF), with benefits most evident among patients with EF below normal. However, the adoption of S/V among patients with EF &gt;40% in US clinical practice is unknown. Methods: We identified hospitalizations for HF in the AHA Get With The Guidelines®-Heart Failure registry between January 2016 and December 2021 among patients with EF &gt;40% to 60%, and not receiving dialysis. We evaluated prescription of S/V at discharge, and compared patient characteristics among those prescribed and not prescribed S/V. We also assessed temporal trends in S/V discharge prescription before and after FDA label expansion. We considered prescriptions of S/V on or after March 1, 2021, to have occurred after FDA label expansion. Results: Among 151,763 hospitalizations for patients with EF &gt;40-60%, 3,001 (2.0%) included a prescription for S/V at discharge. Patients prescribed S/V were more likely to be younger, male, Black race, and privately insured compared with those not prescribed S/V (Figure, Panel A). Those prescribed S/V had lower EF (median 48% [Q1 45%, Q3 55%] versus 55% [50%, 58%]), lower blood pressure, lower rates of kidney disease, and higher rates of ischemic HF and diabetes. Following FDA label expansion, discharge prescription of S/V in the study population more than doubled compared with earlier years (4.3% vs 1.6%; p&lt;0.001), but absolute rates remained low. ( Figure, Panel B ). Conclusion: Although the rate of S/V prescription among HF patients with EF &gt;40-60% has significantly increased following FDA label expansion, use of S/V among these patients remains low. Compared with patients not prescribed S/V, patients with EF&gt;40-60% receiving S/V at discharge have a distinct demographic and clinical profile, including tendency for HFmrEF more than HFpEF.
Abstract 12608: Design and Fabrication of a Working Tissue Model of the Developing Embryonic Heart
Authors: Joshua R Gershlak, Kenji Miki, Harald Ott
Journal: Circulation (2022)

Introduction: Currently, there are no in vitro models that fully recapitulate cardiogenesis. Knowledge gained by a three-dimensional model of cardiogenesis could be useful to improve techniques to engineer heart tissue or to act as a model of the onset of congenital heart defects. Within this study, we designed a tissue engineered model of the embryonic heart tube that undergoes the looping phenomenon. Methods: Embryonic heart tubes (EHT) were engineered using a novel casting method (Figure 1A, B). Tubes were created through serial castings resulting in an inner acellular layer surrounded by a thin iPS derived cardiomyocyte layer, mimicking the in vivo cross-sectional anatomy. In the developing heart, looping is driven through both internal and external forces, leading to elongation of the tube resulting in a rightward rotation at the cranial end of the embryo and a dorsal deflection at the caudal end. To mimic this, we designed a bioreactor system (Figure 1C) that would enable 180°rotation on the “cranial end”, 300% dorsal deflection on the “caudal end”, shortening by 100% for the entire tissue. Results: EHTs were maintained for seven days via perfusion culture (Figure 1D). Histologic analysis confirmed cross-sectional orientation that matches the native heart tube at day 22 (Figure 1B). EHTs were found to remain patency, perfusability and viability during culture (Figure 1E). When exposed to external forces within the bioreactor, tubes looped similarly to what is seen during cardiogenesis with both ends fusing together into a primitive four-chambered shape (Figure 1D, F; numbers indicate location within the tissue the image was taken), including potential ventricular septal formation (white arrow). Conclusions: We successfully engineered a heart tube model that mimics the cross-sectional anatomy and looping of the embryonic heart tube. This model could be further expanded to further study cardiogenesis or modified to study the onset of congenital heart defects.
Abstract 11829: Cardiac Arrhythmias and Associated Mortality Risks in Alzheimer's Disease Patients Following STEMI and NSTEMI Hospitalization
Authors: Nomesh Kumar, Kamleshun Ramphul, Jyotsnav Joynauth, Renuka Verma, Stephanie G Mejias, Komal Kumari, Yogeshwaree Ramphul, fnu Bawna, Mohammed Elmahal, Batool Jawaid, Syed Hamad Ali Shah, Shaheen Sombans, Fnu Arti, Petras Lohana
Journal: Circulation (2022)

Introduction: Little is known about the outcomes of patients with Alzheimer’s disease (AD) following acute myocardial infarction (AMI). Methods: We used the 2017 National Inpatient Sample, including patients ages ≥60 with a primary diagnosis of STEMI and NSTEMI and those with any diagnostic code for AD. Any differences between AD and non-AD patients were calculated via Chi-square tests. The mortality rates of each group and their odds ratio (aOR) adjusted via multivariable logistic regression were also found. Results: A total of 104,860 cases of STEMI and 352,120 patients of NSTEMI were identified, amongst which 1,130 and 5,810 also had a diagnosis of Alzheimer’s disease. The incidence of Atrial flutter (160 cases, 1416 cases per 10,000 AD patients with STEMI), atrial fibrillation (320 cases, 2832 cases per 10,000 AD patients with STEMI), and long QT syndrome (15 cases, 133 cases per 10,000 AD patients with STEMI) for STEMI patients were higher among the AD patients (p&lt;0.05). The incidence of ventricular fibrillation was lower among the AD group (30 cases, 265 cases per 10,000 AD patients with STEMI) compared to the non-AD group (762 cases per 10,000, p&lt;0.01). Among the NSTEMI patients, the ventricular fibrillation rate was lower among AD patients (30 cases, 52 cases per 10,000 AD patients with NSTEMI) compared to the non-AD group (120 cases per 10,000 cases, p&lt;0.01), and a higher number of atrial fibrillation was seen in AD patients (1755 cases, 3021 cases per 10,000 AD patients with NSTEMI) compared to non-AD patients (2589 cases per 10,000 cases, p&lt;0.01).Finally, 25.7% of all AD cases with STEMI died (aOR 2.68, 95% CI 2.33-3.08, p&lt;0.01), while 9.6% of AD cases with NSTEMI did not survive their hospitalization (aOR 2.28, 95% CI 2.08-2.50, p&lt;0.01). Conclusions: Our results provide a new perspective on arrhythmias following myocardial infarction and the risk of death in patients with Alzheimer’s disease. It may be linked with A-beta amyloid 40 and 42 in the myocardium or mutations in PSEN1 and PSEN2 genes. Clinically, AD should be considered significant comorbidity during the hospitalization for AMI, and regular cardiac monitoring may be helpful to avoid any deadly outcomes.
Abstract 12314: Bivalirudin versus Unfractionated Heparin During Percutaneous Intervention for Chronic Total Occlusion: A Systematic Review and Meta-Analysis
Authors: Cameron Burmeister, Sami Ghazaleh, Neha Patel, Sapan Bhuta, Omar Sajdeya, Clarissa Pena, Mohammad Safi, Abdulmajeed Abdullah Alharbi, Sadikshya Sharma, Mohammad Yassen, Azizullah Beran, Mohammed Mhanna, Ehab Eltahawy
Journal: Circulation (2022)

Introduction: Chronic total occlusion (CTO) percutaneous intervention (PCI) is an evolving challenge within interventional cardiology. Anticoagulation during percutaneous intervention remains part of the standard of care for patients undergoing PCI to prevent thrombotic complications peri-procedurally. Unfractionated heparin (UFH) is a commonly used for CTO PCI-related anticoagulation. However, bivalirudin (BV), a synthetic, reversible, direct thrombin inhibitor, has been utilized as an alternative to UFH in CTO patients undergoing PCI. This meta-analysis aims to investigate the efficacy and safety of bivalirudin versus UFH for CTO PCI. Methods: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases through May 2022 for all studies evaluating efficacy and safety of bivalirudin versus UFH in CTO patients undergoing PCI. The primary outcome was mortality. Secondary outcomes were major adverse cardiac events (MACE), major bleeding events, peri-procedure myocardial infarction (MI), in-stent thrombosis, and unplanned revascularization. Pooled risk ratio (RR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effects model. Heterogeneity was assessed by I2 statistic. Results: A total of 5 studies containing 1347 patients with CTO undergoing PCI on anticoagulation (631 BV versus 716 UFH) were included. No significant difference existed between BV and UFH regarding mortality [RR: 0.54 (95% CI: 0.19-1.56); P 0.26 , I2 0%]. Major bleeding events were significantly lower in BV compared with UFH [RR: 0.33 (95% CI: 0.19-0.66); P 0.001, I2 0%]. MACE [RR: 0.75 (95% CI: 0.55-1.00); P 0.05, I2 2%], peri-procedure MI [RR: 0.80 (95% CI: 0.56-1.15); P 0.24, I2 0%], in-stent thrombosis [RR: 0.68 (95% CI: 0.19-2.39); P 0.55, I2 17%] and unplanned revascularization [OR: 0.77 (95% CI: 0.29-2.07); P 0.61, I2 0%] were similar between the two groups. Conclusions: BV seems to be safer than UFH in preventing major bleeding in anticoagulated patients with CTO undergoing PCI; there is no significant difference between groups in terms of mortality, MACE, peri-procedure MI, in-stent thrombosis, or unplanned revascularization. Future randomized controlled trials are needed.
Abstract 11059: Sexual Dimorphism of Therapeutic Fasting in Mitigating Metabolic and Cardiovascular Dysfunction in Prediabetes: Possible Role of Adipose Dysfunction
Authors: Haneen Dwaib, Ghina Ajouz, Nahed Mougharbil, Omar Obeid, Ahmed El-Yazbi
Journal: Circulation (2022)

Our previous work on non-obese prediabetic male rats showed that early cardiovascular (CV) and metabolic impairment was associated with localized perivascular adipose tissue (PVAT) dysfunction characterized by inflammation and hypoxia fueled by uncoupling protein 1 (UCP1) overexpression and hypertrophied adipocytes.Since there has been neither recommendations for pharmacological treatment for interrupting the hypoxia machinery in PVAT, nor a clear understanding of sexual dimorphism in PVAT involvement at this stage, therefore, we hypothesized that therapeutic fasting (TF) can alleviate PVAT dysfunction, metabolic and CV stress among prediabetic rats in a sex dependent manner. Male and female rats were fed ad libitum either a control or a mild hypercaloric diet (MHC) for 12 weeks, the typical protocol to induce prediabetes in male rats. To assess the role of female sex hormones 3 additional groups of females were bilaterally ovariectomized (OVX) on week 12. Afterwards, only the TF groups were subjected to daily fasting from 7.00pm-7.00am for 12 weeks with free access to water and to MHC during the light phase. Food intake, body composition, blood pressure, blood glucose profile, echocardiography, and serum lipid profile were examined regularly. At week 24 rats were catheterized for invasive hemodynamic examination, to assess baroreceptor sensitivity. After sacrifice, aortic contractility and endothelial function were assessed and molecular investigations were performed on various pools of adipose tissue.MHC feeding induced non-obese prediabetes, signs of early cardiovascular and metabolic dysfunction with PVAT impairment malfunctioning brown adipose tissue (BAT) only in male rats. Intact female rats resisted MHC-induced derangements, while OVX rats presented an obese prediabetic phenotype, with CV and metabolic impairment and PVAT dysfunction. Strikingly,TF in the presence of MHC feeding and in the absence of calorie restriction, and estrogen in the case of females, seemed to substantially correct these dysfunction in both male and OVX rats and interrupt hypoxia in PVAT and BAT in a UCP1 dependent manner. Taken together, our work suggests a novel mechanistic understanding of which TF interferes with the hypoxia machinery in PVAT
Abstract 12083: Highly Caffeinated Energy Drinks and Genetic Heart Disease-Associated Sudden Cardiac Arrest
Authors: Sahej Bains, Johan M Bos, David J Tester, Ciorsti MacIntyre, John Giudicessi, Michael J Ackerman
Journal: Circulation (2022)

Background: Highly caffeinated energy drinks (HCEDs) can trigger life-threatening cardiac arrhythmias in individuals with and without an underlying genetic predisposition. Though the mechanism(s) responsible for these events remain unclear, it has been postulated that high caffeine may alter heart rate, blood pressure, cardiac contractility, and cardiac repolarization in a manner that is pro-arrhythmic. Objective: To describe our experience regarding sudden cardiac arrest (SCA) events occurring in proximity to HCED consumption in patients with underling genetic heart diseases. Methods: All SCA survivors referred to the Mayo Clinic Windland Smith Rice Genetic Heart Rhythm Clinic for clinical and/or molecular evaluation were reviewed to identify those with a history of HCED consumption prior to their event. Patient demographics, clinical characteristics, documented HCED consumption, and temporal relationship of HCED consumption to SCA were extracted from the electronic medical record. Results: Among 144 SCA survivors with a structurally normal heart, 8 (6 females; mean age at event 28 ± 8 years) experienced an unexplained SCA associated temporally with HCED consumption. Of these, 5 (63%) had either long QT syndrome (n=3) or catecholaminergic polymorphic ventricular tachycardia (n=2). The remaining 3 were diagnosed with unexplained SCA/idiopathic ventricular fibrillation after a comprehensive evaluation. Three patients (37%) were habitual HCED consumers while 5 (63%) imbibed for the first time with consumption ranging from several hours to a few minutes before the SCA. Seven patients (88%) required a rescue shock (average 2 ± 2 shocks/patient) while 1 was manually resuscitated. Upon follow-up, 6 (75%) were dismissed with an implantable cardioverter defibrillator, 1 (13%) on pharmacologic therapy, and 1 (13%) underwent denervation surgery. All SCA survivors have quit drinking HCEDs and have been event-free since. Conclusion: Overall, 8/144 (5.6%) of SCA survivors evaluated in our program experienced a SCA in proximity to consuming a HCED. Although larger cohort studies are needed to elucidate the precise mechanism for HCED-triggered/associated SCA and quantify its precise pro-arrhythmic risk, it seems prudent to sound an early warning.
Abstract 12400: The LDL-C / ApoB Ratio Predicts Future Cardiovascular Events in Cardiovascular Disease Patients With Nonalcoholic Fatty Liver Disease as Well as in Those Without Nonalcoholic Fatty Liver Disease
Authors: Maximilian Maechler, Lukas Sprenger, Arthur Mader, Barbara Larcher, Alexander Vonbank, Andreas Leiherer, Axel Muendlein, Heinz Drexel, Christoph H Saely
Journal: Circulation (2022)

Introduction: A low LDL-C / apoB ratio reflects small LDL particle size and is associated with insulin resistance. Non-alcoholic fatty liver disease (NALFD) is an important feature of the insulin resistance syndrome and confers an increased cardiovascular risk. The impact of the LDL-C / apoB ratio on the risk of cardiovascular events in patients with NAFLD is unclear. Hypothesis: We hypothesize that the LDL-C/apoB ratio predicts cardiovascular events in patients with NAFLD. Methods: We enrolled a large high risk cohort of 1515 patients with established cardiovascular disease (1272 patients with angiographically proven stable CAD and 243 patients with sonographically proven peripheral artery disease). NAFLD was diagnosed using the validated fatty liver index. Prospectively, cardiovascular events were recorded over a mean follow-up period of 7.6±4.9 years. Results: At baseline, the LDL-C / apoB ratio was significantly lower in patients with NAFLD (n=709) than in subjects who did not have NAFLD (1.34±0.29 vs. 1.39±0.26 mg/dl; p=0.001). During follow-up, 755 patients suffered cardiovascular events. The event rate was higher in patients with than in those without NAFLD (53.6 vs. 47.6%; p=0.020). The LDL-C/ApoB ratio significantly predicted cardiovascular events in the total study cohort, with a standardized adjusted hazard ratio (HR) of 0.86 [0.80-0.94]; p&lt;0.001 and both in patients with NAFLD (HR 0.87 [0.78-0.97]; p=0.013) and in subjects who did not have NAFLD (HR 0.87 [0.77-0.97]; p=0.013, respectively). Conclusions: We conclude that in subjects with established cardiovascular disease the LDL-C / apoB ratio predicts cardiovascular events both among patients with NAFLD and in those who do not have NAFLD.
Abstract 12126: Trends in Lipoprotein(a) Testing in Individuals With Cardiovascular Disease
Authors: Harpreet S Bhatia, Paresh Desai, Wenhong Zhu, Sotirios Tsimikas, Calvin Yeang
Journal: Circulation (2022)

Introduction: There is consensus amongst major international societal guidelines including the AHA/ACC that elevated lipoprotein(a) [Lp(a)] &gt; 50 mg/dL, present in 20% of the population, is a likely causal, independent, and hereditary risk factor for several cardiovascular (CVD) conditions. Despite its high prevalence, clinical measurement of Lp(a) has anecdotally been considered rare but has not been systematically quantified. Methods: We assessed the prevalence of Lp(a) testing for various CVD conditions across six academic medical centers associated with the University of California (UC), in total and by year from 2012-2021. Data from the UC data warehouse on unique CVD diagnoses using ICD codes, and unique Lp(a) testing for individuals with each diagnosis were collected. The proportion of individuals with a given CVD diagnosis and Lp(a) testing at any time during the study period or in the same year of their diagnosis was quantified. Finally, we evaluated the prevalence of elevated Lp(a) (&gt;30 mg/dL and &gt;50 mg/dL) for each diagnosis. Results: From 2012-2021, there were 18,830 unique Lp(a) tests. Lp(a) testing was performed in 6,855 individuals with ischemic heart disease (3.1%), 2,454 (3.4%) with MI, 1,157 (2.1%) with PVD, 1,261 (3.4%) with carotid stenosis, 1,250 (1.8%) with stroke, 908 (3.4%) with aortic stenosis, and 5,136 (3.6%) with a family history of CVD. For most conditions, the prevalence of testing in the same year as the diagnosis of CVD was relatively consistent over the study period, except for a progressive increase among those with MI ( Figure ). Across CVD diagnoses, the prevalence of Lp(a) &gt;30mg/dL was 47.9 to 55.3% and for Lp(a) &gt;50 mg/dL was 36.7 to 44.9%. The highest prevalence of elevated Lp(a) was among those with carotid stenosis, and the lowest was among those with family history of CVD. Conclusions: Lp(a) testing persists at low rates, even among those with diagnosed CVD, and remained stable over the study period except for MI.
Abstract 12154: Relationship Between Caffeine Consumption and Young Athletes' Comorbidities, Exercise-Related Symptoms, and Baseline Electrocardiogram
Authors: Jason Farber, Sean Dikdan, Max Ruge, Drew Johnson, David Shipon
Journal: Circulation (2022)

Introduction: Studies on adult athletes have found that caffeine consumption has both positive and negative effects on physical performance and cardiovascular physiology. While roughly 3 in 4 children older than 5 years old consume caffeinated beverages, the effects of caffeine on children and adolescent athletes are less studied. Methods: The HeartBytes National Youth Database produced by Simon’s Heart, a nonprofit organization that organizes pre-participation examinations (PPEs) of adolescents, was utilized for this study. This database contains demographic, exercise-related symptom (chest pain or dyspnea), and electrocardiogram data obtained during Simon’s Heart PPEs. Logistic regression models were adjusted for age, BMI, race, and gender except for the model assessing BMI as an outcome, which adjusted only for age, race, and gender. Results: Of the 7425 patients in the HeartBytes database, the majority were male (60.6%) and White (83.9%). The median age was 15.0 years old (interquartile range 13.5 - 16.5). Those who consumed caffeine were more likely to have a history of ADHD (adjusted odds ratio [aOR] 1.43 [CI: 1.15 - 1.76]; p = 0.001) and a BMI ≥ 30 (aOR 1.69 [CI: 1.27 - 2.25]; p &lt; 0.001) when compared to non-caffeine drinkers. Caffeine drinkers overall were at no higher risk for exercise-related symptoms. However, when type of beverage was assessed, soda drinkers were more likely to have symptoms during exercise (aOR 1.33 [CI: 1.02 - 1.73]; p = 0.032) and coffee drinkers were more likely to have syncope with exercise (aOR 2.13 [CI: 1.20 - 3.60]; p = 0.006) compared to those who do not consume caffeinated beverages. No association was present between caffeine consumption or beverage type and ECG changes. Conclusions: In this dataset from a national registry of PPEs, caffeine consumption was independently associated with obesity and ADHD. While caffeine consumption itself did not increase risk of exercise-related symptoms, soda drinkers were at higher risk for symptoms during exercise, and coffee drinkers were at higher risk of syncope with exercise. The study shows that caffeine consumption may have significant impact on youth health. Future studies are needed to further confirm our findings.
Abstract 12321: Patient-Reported Outcomes in Clinical Studies of Patients With Hypertrophic Cardiomyopathy
Authors: Nosheen Reza, Sharlene Day, Anjali T Owens
Journal: Circulation (2022)

Introduction: Therapy for hypertrophic cardiomyopathy (HCM) is primarily targeted toward alleviation of symptoms and improvement in function and quality of life. Yet, the contemporary landscape of patient-reported outcomes (PROs) in HCM clinical research has not been investigated. Methods: ClinicalTrials.gov was queried to identify clinical studies of HCM that reported PROs as outcome measures. All studies of HCM as the disease condition were included, and PROs were identified using specific search terms in the Outcome Measures field. Study characteristics were collected and compared between those that did versus did not report PROs. Results: From November 1987 to February 2022, 181 studies including participants with HCM were registered on ClinicalTrials.gov. Of these, 35 (19%) included PROs as primary or secondary outcome measures. Studies reporting PROs were more likely to be interventional (85.7% vs. 46.6%; p&lt;0.001) and to involve randomization (65.7% vs. 24.7%; p=0.003) compared with those that did not report PROs. Prior to 2007, no clinical studies that reported PROs were registered in ClinicalTrials.gov; however, PRO reporting has increased over the last 15 years. Ninety-four percent of studies that reported PROs as outcomes enrolled fewer than 500 participants. In total, 66 PRO tools or domains were listed as outcome measures. Of these, the Kansas City Cardiomyopathy Questionnaire (KCCQ) was the most often used. Conclusion: Only approximately one in five registered clinical studies of participants with HCM report PROs. Only one PRO tool, the KCCQ, has been validated in studies of patients with HCM. HCM-specific symptoms such as palpitations, dizziness, angina, syncope, and psychiatric impacts are not adequately assessed by existing PRO tools. Future research is needed to develop and validate PRO tools that adequately capture HCM-specific symptoms and longitudinal health status trajectories in patients with varying HCM subphenotypes.